House Hearing, 114TH Congress - Legislation To Improve and Sustain The Medicare Program

LEGISLATION TO IMPROVE AND SUSTAIN THE
MEDICARE PROGRAM
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON WAYS AND MEANS

U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
JUNE 8, 2016
Serial 114HL09
Printed for the use of the Committee on Ways and Means
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COMMITTEE ON WAYS AND MEANS
KEVIN BRADY, Texas, Chairman
KEVIN BRADY, Texas SANDER M. LEVIN, Michigan
SAM JOHNSON, Texas CHARLES B. RANGEL, New York
DEVIN NUNES, California JIM MCDERMOTT, Washington
PATRICK J. TIBERI, Ohio JOHN LEWIS, Georgia
DAVID G. REICHERT, Washington RICHARD E. NEAL, Massachusetts
CHARLES W. BOUSTANY, JR., Louisiana XAVIER BECERRA, California
PETER J. ROSKAM, Illinois LLOYD DOGGETT, Texas
TOM PRICE, Georgia MIKE THOMPSON, California
VERN BUCHANAN, Florida JOHN B. LARSON, Connecticut
ADRIAN SMITH, Nebraska EARL BLUMENAUER, Oregon
LYNN JENKINS, Kansas RON KIND, Wisconsin
ERIK PAULSEN, Minnesota BILL PASCRELL, JR., New Jersey
KENNY MARCHANT, Texas JOSEPH CROWLEY, New York
DIANE BLACK, Tennessee DANNY DAVIS, Illinois
TOM REED, New York LINDA SA NCHEZ, California
TODD YOUNG, Indiana
MIKE KELLY, Pennsylvania
JIM RENACCI, Ohio
PAT MEEHAN, Pennsylvania
KRISTI NOEM, South Dakota
GEORGE HOLDING, North Carolina
JASON SMITH, Missouri
ROBERT J. DOLD, Illinois
TOM RICE, South Carolina
DAVID STEWART, Staff Director
NICK GWYN, Minority Chief of Staff
SUBCOMMITTEE ON HEALTH
PATRICK J. TIBERI, Ohio, Chairman
SAM JOHNSON, Texas JIM MCDERMOTT, Washington
DEVIN NUNES, California MIKE THOMPSON, California
PETER J. ROSKAM, Illinois RON KIND, Wisconsin
TOM PRICE, Georgia EARL BLUMENAUER, Oregon
VERN BUCHANAN, Florida BILL PASCRELL, JR., New Jersey
ADRIAN SMITH, Nebraska DANNY DAVIS, Illinois
LYNN JENKINS, Kansas JOHN LEWIS, Georgia
KENNY MARCHANT, Texas
DIANE BLACK, Tennessee
ERIK PAULSEN, Minnesota
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CONTENTS
Page
Advisory of June 8, 2016, announcing the hearing ............................................... 2
WITNESSES
PANEL ONE
The Honorable Charles W. Boustany, Member of Congress, Washington,
D.C. ........................................................................................................................ 22
The Honorable Robert J. Dold, Member of Congress, Washington, D.C. ..... 16
The Honorable Kristi L. Noem, Member of Congress, Washington, D.C. ..... 20
The Honorable David G. Reichert, Member of Congress, Washington,
D.C. ........................................................................................................................ 18
PANEL TWO
The Honorable Joseph Crowley, Member of Congress, Washington, D.C. ... 30
The Honorable John B. Larson, Member of Congress, Washington, D.C. .... 28
The Honorable Patrick Meehan, Member of Congress, Washington, D.C. ... 25
The Honorable James B. Renacci, Member of Congress, Washington, D.C. 21
PANEL THREE
The Honorable Alexander X. Mooney, Member of Congress, Washington,
D.C. ........................................................................................................................ 26
The Honorable Christopher H. Smith, Member of Congress, Washington,
D.C. ........................................................................................................................ 33
The Honorable Lee M. Zeldin, Member of Congress, Washington, D.C. ....... 31
SUBMISSIONS FOR THE RECORD

The Honorable Diane Black, statement ................................................................. 48
The American College of Clinical Pharmacy, and The College of Psychiatric
and Neurologic Pharmacists, statement ............................................................ 50
Lymphedema Advocacy Group, statement ............................................................ 53
Medicare Rights, statement .................................................................................... 59
Property Casualty Insurers Association of America, statement .......................... 61
iii
LEGISLATION TO IMPROVE AND SUSTAIN
THE MEDICARE PROGRAM
WEDNESDAY, JUNE 8, 2016
U.S. HOUSE OF REPRESENTATIVES,

COMMITTEE ON WAYS AND MEANS,
SUBCOMMITTEE ON HEALTH,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:20 p.m. in Room
1100 Longworth House Office Building, the Honorable Pat Tiberi
[chairman of the subcommittee] presiding.
[The advisory announcing the hearing follows:]
(1)
2
Insert 21308.001
3
Chairman TIBERI. The subcommittee will come to order. Wel-

come to the Ways and Means Health Subcommittee Member Day
hearing entitled, Legislation to Improve and Sustain the Medicare
Program. Today, similar to our last Member Day hearing on tax-
related proposals to improve health care, this Subcommittee is pro-
viding a public platform for any and all Members of Congress inter-
ested to discuss bills that they have introduced that modify the
way health care is assessed and delivered to more than 55 million
seniors who rely on the Medicare program.
Members have put a lot of work into developing and drafting
these pieces of legislation, and this Member Day hearing is their
opportunity to share with their colleagues and the American people
why these bills are important, and why this Committee should take
them up.
In addition to my colleagues from Ways and Means, I am excited
to hear from Members who serve on other committees who have
worked equally hard on legislation to transform and improve our
Medicare program.
We remain committed to working through regular order. That in-
cludes hearings like the one today from those on and off the com-
mittee.
So how is it going to work? Members will have five minutes to
discuss their Medicare legislative priorities. I would remind those
Members that they are also able to submit written testimony in
support of their legislation.
Insert 21308.002
4
We thank you all, witnesses and members of this Subcommittee,

for taking the time out of your busy schedules to be with us today.
And I hope, Dr. McDermott, we can build on the kind words you
said about us yesterday. I knew it might take a little while for you
to say kind words about us, and we accomplished that. So lets
build on that, sir.
I yield to the ranking member.
Mr. MCDERMOTT. Thank you, Mr. Chairman. We might as well
start out on a good note. And I think that I want to thank you for
holding this Member Day hearing to improve and sustain Medi-
care. I welcome this opportunity to learn more about the ideas that
my colleagues may have, and they will discuss today.
When it comes to Medicare, the policies which were put in place
in 1965, those policies we have made a wide range of interests
physicians, insurers, hospitals, and many others. And the most im-
portant people affected, however, by Medicare are the beneficiaries,
the 55 million seniors and Americans with disabilities who depend
on Medicare for their health care.
At its core, Medicare is a fulfillment of a commitment to the
health security of the American people. Individuals who have con-
tributed to the system deserve the peace of mind of knowing that
Medicares benefits will be there when they need them. That means
that Congress must work to ensure that Medicare truly strength-
ens the quality and accessibility of beneficiaries health care.
A strong Medicare doesnt mean we turn the program over to the
insurance industry, and it doesnt mean we shift more costs on to
the beneficiaries. A stronger Medicare is a program that provides
comprehensive coverage to beneficiaries at affordable cost. To make
that a reality we have to move the conversation in Congress away
from harmful ideas like privatizing the program and cutting sen-
iors benefits toward a more productive discussion of how to make
Medicare work better for beneficiaries.
To that end, I intend to discuss legislation I have recently intro-
duced which will provide beneficiaries with access to comprehen-
sive dental, vision, and hearing services. This is a popular, long-
overdue reform that will improve the health security of millions of
Americans. And I look forward to talking further about the impor-
tance of this during the hearing.
I also hope to hear from my colleagues about other ideas that
will continue to build upon and expand Medicare. I intend to care-
fully scrutinize ideas that may not be in the best interests of the
program or the beneficiaries. Todays hearing is a part of what
must be an ongoing process of careful debate that will show the
American people what Congress is doing or not doing to improve
health security.
When Medicare was put in place, the life expectancy in this
country was about 10 years lower than it is today. So we had such
success in Medicare that we have got a whole lot of new problems
that we didnt have before. It must be followed by substantive legis-
lative hearings and markups and amendments, so that we could
weed out bad ideas and make sure the ones that are good can have
the passage of this Congress.
Thank you again, Mr. Chairman, for bringing this day together,
and I look forward to hearing the witnesses.
5
Chairman TIBERI. Thank you, Dr. McDermott. Without objec-

tion, other Members opening statements will be made part of the
record.
Now we will hear from Members of the Subcommittee on their
priorities to improve Medicare. I am the lead Republican on the
Medicare Home Infusion Site of CARE Act, which we are working
with the Senate and CMS to ensure it will work for all stake-
holders. It is truly an important piece of legislation that will ex-
pand beneficiary access to infusion treatments in their homes, if
that is where they choose to receive their care, something that pri-
vate providers already cover.
I look forward to continuing to work on this legislation that will
increase beneficiary access to appropriate and cost-effective care,
and advancing it when it is ready.
Chairman TIBERI. With that, I turn to my left, literally, to Dr.
McDermott once more for the purposes of discussing his legislation.
Dr. McDermott, you are recognized for five minutes.
Mr. MCDERMOTT. We welcome you on the left. I would like to
ask unanimous consent to enter into the record a letter from the
Medicare Rights organization dated 8 June 2016.
Chairman TIBERI. Without objection. Without objection.
[The information follows: The Honorable Jim McDermott]
6
Insert 21308.003
7
f
Insert 21308.004
8
Mr. MCDERMOTT. Mr. Chairman, I have sat here on this Com-

mittee for 25 years and watched lots of things happen. And I am
really glad that we are having a hearing today when we could put
some ideas up on the table that we havent had before.
I am introducing today a bill called the Medicare Dental, Vision,
and Hearing Act, a bill I introduced, I guess, yesterday, actually.
The creation of Medicare in 1965 was one of the great policy
achievements in the history of this country. The benefits that Medi-
care provided ensured that 55 million citizens and people with dis-
abilities would enjoy the peace of mind and the security that comes
with having quality health coverage. The best way to improve and
sustain Medicare is by expanding it and strengthening it because,
unfortunately, there are holes in the program that weaken health
security of our beneficiaries.
One of the largest holes in the Medicare system is that it does
not currently cover most dental, vision, or hearing expenses. In
fact, not only does it not pay for these crucial health services, they
are specifically excluded from coverage by the statute that was
passed in 1965. This is a misguided policy that, for decades, has
had harmful consequences on beneficiaries.
Doing without dental coverage frequently leads to preventable
health problems. Patients who have poor or no dental care often
find themselves suffering from costly and potentially fatal condi-
tions such as cardio-vascular disease and oral cancers. We had re-
cently here in Washington, D.C. a young kid who didnt have den-
tal care and got encephalitis of the brain from an infected tooth.
Now, similar untreated vision disorders substantially increase
the risk of falls among senior citizens. One of the biggest problems
for senior citizens is falling. And if they have bad vision and dont
have glasses, or they got cataracts or whatever, they are having
trouble. These falls can result in serious injuries and expensive
hospitalizations.
Hearing loss, for those of us who grew up in the age of rock
music, and used to stand next to the woofers and the tweeters at
full volume, today have hearing aids because we did things with
our ears that we didnt understand then. There are lots and lots
of seniors who have hearing loss and that is an isolating event.
When you have no ability to hear, you are cut out of everything.
And that is why it isif we are having seniors live longer and
longer and longer, into their eighties and nineties, we are going to
see more of the hearing and the vision loss that we have not dealt
with in the past. It is a widespreadthe hearing loss is as wide-
spread among Medicare beneficiaries, often leading to social isola-
tion, depression, and cognitive impairments. We wind up treating
them for depression, we treat them for all kinds of other things, ba-
sically, because they cant hear.
Yet research shows that a majority of the elderly who need hear-
ing aids do not have them, in large part due to cost. That is why
the reforms made by the Medicare Dental, Vision, and Hearing
Benefit Act are so important. This bill modernizes and strengthens
Medicares benefit package to address the full spectrum of bene-
ficiaries health needs. It amends Part B to provide coverage of im-
portant health services, including routine and major dental care,
refractive eye exams, and hearing exams, and adds coverage for im-
9
portant supplies including dentures, glasses, and hearing aids. It

repeals the harmful statutory exclusions that prevent Medicare
from paying for these costs.
And to control costs and ease the burden as we implement these
major reforms, it places reasonable limitations on coverage and
provides that new benefits will be phased in gradually. All too
often at this Committee our policy discussions focus on how much
we can cut from Medicare and how to further shift the costs onto
beneficiaries. In the process we fail to recognize the possibilities be-
fore us and the enormous power we wield.
The truth is that Medicare must be strengthened, not cut, and
benefits must be expanded, not scaled back. As the Ways and
Means Committee, we owe a duty to the American people to dis-
cuss how we can make that happen.
And I yield back the balance of my time. I thank the chairman.
Chairman TIBERI. Thank you. Thank you, Dr. McDermott. My
phone was ringing and I was thinking it was my mom and dad call-
ing me about your legislation there.
[Laughter.]
Chairman TIBERI. Very well done. Mr. Roskam is recognized for
five minutes.
Mr. ROSKAM. Thank you, Mr. Chairman and Ranking Member
McDermott. Five minutes, three bills, let me do this quickly. Buck-
le up, I think I can do it.
So H.R. 512 is the Disarm Act, and it is designed to incentivize
the development of new antibiotic drugs. The Administration recog-
nizes that we have an incredible problem here. The CDC recognizes
that we have an incredible problem here. And the incredible prob-
lem is that we have got infections that are unwilling to yield to
some of the antibiotics, and we dont have enough incentive out
there in the private sector to invest, essentially. And this is a
plague.
Let me just give you one quick example. In March and April in
the Midwest 18 people died from 57 inspections in 3 states. And
this is here, it is upon us, and we need to deal with it. H.R. 512
would address this by reimbursing hospitals for the cost of acquired
new certain agents.
It passed in Chairman Uptons Cures Act. We will see where that
is in the Senate, Mr. Chairman, but in my view, we would be wise
to reclaim jurisdiction here and move it again.
Bill number two, H.R. 3220, the Common Access Card. This is
a bill that I have introduced with Mr. Blumenauer. Some of the
work of the Oversight Subcommittee has shown that the fraud and
erroneous payments rate at Medicare is 12.7 percent. I mean this
is a shocking figure. And, you know, you begin to ask yourself,
How is this possible? Well, it is possible in part because you got
these flimsy old Medicare cards, and it is a bunch of nonsense.
And what we are proposing is this, to take the technology that
the Department of Defense uses currently, try a pilot program, and
create a common access card.
Ready for a statistic? February 2016, a few months ago, GAO re-
vealed that 22 percent of health care fraud cases ultimately pros-
ecuted by the Federal Government could have been prevented by
use of a smart card22 percent. Marinate in that for a second.
10
When we are running around here, grubbing around, looking for

nickels and dimes, thinking about 22 percent, thinking about 12.7
percentyou take my point.
So here is what we need to do. We need to pass this bill, number
one. But you need to give us good feedback.
I spoke with Secretary Burwell this week. She is committed to
expediting a meeting to get stakeholders together. And I think we
can do a lot of good work here. And, Dr. McDermott, I am looking
to you to get on this bill.
And then finally, the H.R. 4853 is the SAFE Act. And in a nut-
shell, this legislation provides CMS with additional flexibility to
permit approved private-sector accreditors to use their own up-
dated standards and survey processes for hospital accreditation. So,
in other words, we have got the private sector that is doing a fabu-
lous job, we have got a statute that basically tethers us to an old
system. So lets dump the loser stuff, pick up the things that work,
and lets adopt it so that these hospitals can move forward on that
basis, to allow accrediting bodies to use assessment methods that
incorporated the latest, best practices in health care delivery to en-
sure hospitals adhere to high-quality standards and patient safety.
And Mr. Chairman, who doesnt love that? And I yield back.
Chairman TIBERI. Well done, Mr. Roskam, thank you very
much.
Before I yield to Mr. Davis for five minutes, I just want to thank
him for coming down to the floor yesterday and his kind words on
the bill that originated in this Subcommittee, and thank all the
Members for their input on a bill that passed the floor unani-
mously yesterday.
So with that, Mr. Davis, you are recognized for five minutes.
Mr. DAVIS. Thank you, Mr. Chairman. And I shall discuss H.R.
2124, the Resident Physician Shortage Reduction Act, introduced
by Representatives Crowley and Boustany.
Mr. Chairman and Ranking Member, the Illinois 7th Congres-
sional District, which I represent, contains the most hospital beds
of any congressional district in the nation, and is also home to four
major academic medical centers. Given our nations growing and
aging population, coupled with the coverage expansion contained in
the Affordable Care Act, the demand for health care continues to
increase, especially for those with complex health care needs, such
as the fastest-growing population in the nation of those aged 75
and older.
Recent studies show that our nation will need as many as 90,000
new physicians over the next decade, and as many as 63,000 of
which will need to be specialists.
Clearly, today more than ever, Congress should maintain and en-
hance our nations investment in training tomorrows physician
workforce. Given that it takes anywhere from 5 to 10 years to train
a physician, the question facing Congress is what are we doing to
ensure that our nation is physician workforce ready to meet our
nations health care needs both today and in the future?
The teaching hospitals in my district are incurring the costs of
these programs significantly greater than the direct and indirect
graduate medical education payments they received. In fact, most
of the major teaching hospitals in Chicago are training in excess
11
of 100 doctors over the residency cap, which costs tens of millions
of dollars that will never be reimbursed to those institutions for
training more physicians to address the growing shortages in pri-
mary care and acute surgical specialties.
Medical schools and teaching hospitals are also working to en-
sure that new doctors coming into the system are trained to serve
in new delivery models that focus on care coordination and quality
improvement. According to the latest physician workforce projec-
tions, roughly two-thirds of the shortage in coming years will be in
specialty practice areas such as neurology, pediatrics, subspecial-
ties, geriatrics, and oncology.
We need more doctors and allied health professionals to assist a
health care system that for decades was not adequately addressed
in health disparities among millions of racial and ethnic minority
Americans. Many of our minorities are disproportionately more
likely to suffer deleterious health just because they are low-income
wage owners, poor in health, and suffer worse health outcomes,
and are more likely to die prematurely and often from preventable
causes compared to other members of the population.
This bill provides a greatly needed opportunity to train the phy-
sicians that we need throughout our country. I am delighted that
Representative Crowley and Representative Boustany have collabo-
rated to pass it. And I would urge all of my colleagues, certainly,
to be in support of it.
And Mr. Chairman, I thank you and yield back the balance of
my time.
Chairman TIBERI. Thank you, Mr. Davis.
Dr. Price, you are recognized for five minutes.
Mr. PRICE. Thank you, Mr. Chairman, and I appreciate the op-
portunity to discuss bills relating to a very important subject, and
that is the issue of saving and strengthening and securing Medi-
care. The demographic challenges that we have in this country are
huge, and Medicare is running out of resources, as you well know.
That is according to their own trustees.
The challenge that we have right now is that CMS is saving
money, according to them, by decreasing services and limiting ac-
cess to care. And it is happening right now, it is not happening just
in a fictitious way potentially in the future.
I want to talk about three pieces of legislation. The first is H.R.
5210, which deals with durable medical equipment, patient access
to durable medical equipment. CMS instituted what is called a
competitive bidding program for suppliers of durable medical
equipment that is not either competitive and isnt bidding, and it
isnt because it doesnt hold bidders accountable, it doesnt ensure
that bidders are qualified to provide the products in the bid mar-
kets, and it produces bid rates that are financially unsustainable.
Mr. Chairman, this literally is harming lives, as we speak. Es-
sential services, including oxygen, are being denied to patients be-
cause of difficulty gaining those services. In rural areas it is a
huge, huge problem. Many areas, many rural areas of the country,
the amount paid for these services doesnt even cover the costs. So
you get decreased availability.
In Georgia, for example, 20 percent decrease in the number of
DME suppliers in the last three years, and a nearly 40 percent re-
12
duction in medical equipment supply stores in our state, just in the

last 3 years. Patients lives are literally at risk.
The National Minority Quality Forum has data that dem-
onstrates it is driving up costs by avoidable hospital bills and in-
creasing out-of-pocket payments by patients. It has led to increased
mortalitythat means death and hospitalizations and a higher cost
for Medicare beneficiaries. The OIG for Medicare itself said that
CMS paid over $1 million to 63 suppliers for product categories
they werent even licensed to provide in their state, over $1 million.
So, H.R. 5210 would simply delay the onset of this competitive
bidding program and expanding the onset of the program, and that
is a bipartisan-supported bill.
Second is H.R. 4848, the Healthy Inpatient Procedures Act,
called the HIP Act. As an orthopedic surgeon, I bear some famili-
arity with this area. This is talking about the comprehensive care
joint replacement, or CJR, model. This is something that CMS put
in place to try to decrease amount of resources spent on lower-ex-
tremity joint replacements. The problem is they have gotten it all
wrong. It is what they call a demonstration product, but it is the
first mandatory demonstration product.
So, how it could be a demonstration product and be mandatory
is beyond me. Sixty percent of the hospitals, as estimated, will be
penalized because of this. Decreasing resources available for pa-
tients to utilize for lower-extremity joint replacement. So what hap-
pens? Medicare CMS limits access, limits choice, increases consoli-
dation of services, and therefore, increases prices.
What does this mean to patients? As a formerly practicing ortho-
pedic surgeon, I would talk to patients about what kind of replace-
ment they ought to have. And Medicare may or may not agree with
that. The problem with this is that, if Medicare doesnt agree with
it, then guess who doesnt get the joint replacement that they need?
It is the patient.
So the H.R. 4848 would delay onset of this program until Janu-
ary 2018. Again, it is a bipartisan support, it would simply give
docs time to get ready for it and give us an opportunity to modify
this program.
And then, finally, H.R. 5001. Everybody has heard from their
docs about the issue of electronic medical records. It is a disaster
for physicians back home. The amount of time that they are having
to spend on this to simply comply with regulations that dont in-
crease the quality of care to patients is astounding.
What Medicare did this year is to change the meaningful use re-
porting period from a 90-day period, rolling 90-day period where
docs would have to comply, to 365 days, which means the entire
year, which means you cant have your server go down, you cant
have any problem at all throughout the course of the year, or you
get dinged by Medicare for not having what they believe is the ap-
propriate electronic medical record. This bill would simply return
it to the 90-day reporting period that we have had in the past.
Again, common sense, bipartisan.
I appreciate the opportunity to present these, and look forward
to them passing.
Chairman TIBERI. Thank you, Doc. With that, Representative
Buchanan of Florida is recognized for five minutes.
13
Mr. BUCHANAN. Thank you, Mr. Chairman, for holding this im-
portant hearing. Before discussing my legislation I would like to
mention the importance of examining medical competitive bidding
also, as Dr. Price has clearly taken the lead on this, but has a huge
impact on my region in Florida, especially Sarasota, but all
through Florida. A lot of diabetics are very concerned about the im-
pact it is going to have on them going forward.
So I appreciate, Dr. Price, your leadership. And hopefully this is
something we can get done quickly.
Now, as for my legislation, along with my good friend, Congress-
man Pascrell, I introduced the Preserving Patient Act [sic] to Post-
Acute Hospital Care, H.R. 4650.
Right now, tens of thousands of Medicare patients rely on access
to highly specialized care facilities known as long-term acute care
hospitals, or LTACs after they are released from intensive care
units. These facilities are uniquely equipped to care for chronically
ill patients over an extended period of time. And unless Congress
acts, the allowable caseload for these facilities will be cut in half
January 1, 2017.
So in six months it would be cut in half. This means people will
either remain stuck in the hospital ICU longer than they want to,
or be forced to move to another place, away from their homes and
families, to find care that they need.
My bill prevents this cut from taking place, and Congress has ap-
proved similar measures several times over the last decade. We
need to act soon. The cut takes effect at the end of the year, but
these facilities need time to plan for their patients care. If we fail
to pass this bill, more than 100,000 seniors could be denied vital
care at their local ATAC hospital.
With that, I yield back.
Chairman TIBERI. Thank you, Mr. Buchanan, and thank you for
bringing up Dr. Prices bill. I too share that concern with respect
to the durable medical goods issue, and have had constituents in
my region of Ohio express concern. So I look forward to working
with you on that, Dr. Price.
Ms. Jenkins, CPA Jenkins, you are recognized for five minutes.
Ms. JENKINS. Thank you, Mr. Chairman, and thank you for
holding this important hearing and allowing me an opportunity to
speak on bipartisan legislation that I am proud to advocate for that
will allow more beneficiaries to access vital care in rural areas,
save Medicare patients in the system money, and ensure its sta-
bility for generations to come.
H.R. 1202, the Medicare Patient Access to Hospice Act, which I
introduced with Congressman Thompson, will allow physician as-
sistants to receive reimbursement from Medicare as the attending
physician in a hospice setting. Hospice care is incredibly important
in my district because of the lack of hospitals and doctors offices
that urban districts have with large health systems.
Along with allowing physician assistants the ability to perform
cost-saving medical care in hospice setting, H.R. 1784, the MEND
Act, which I introduced with Congressman Tonka, will bring about
an out-of-date CMS regulation in line with the accreditation body
that allows hospital-based nursing programs to produce nurses and
shore up critical shortage in the Medicare system.
14
A third bill, H.R. 2138, the Medicare Access To Rural Anesthesia

Act, which I introduced with Congressman Cleaver, will pay anes-
thesiologists in certain rural hospitals under Medicare Part A for
their services at the rate paid to a certified registered nurse anes-
thetist in those hospitals for the same services.
As I pointed out with H.R. 1202, Medicare beneficiaries in Kan-
sas must use entire days sometimes to travel to certain hospitals
to get care. Many of those hospitals cant afford a full-time anesthe-
siologist, so those folks are then forced to travel somewhere else to
get care. H.R. 2138 will help eliminate that burden and allow more
rural hospitals to hire and keep anesthesiologists on staff.
Similarly to that bill, H.R. 3355, which I introduced with Con-
gressman Lewis, will allow physician assistants, nurse practi-
tioners, and clinical nurse specialists to supervise cardiac intensive
care and pulmonary rehabilitation programs. Again, this will allow
critical access and rural hospitals to hire and keep these vital staff
members and provide needed care to rural parts of Kansas and the
United States. Americans living on farms and ranches and those
rural areas have the same need for medical services as those living
in urban areas. And this legislation will give them more adequate
service and keep costs down for the patients and the whole system.
I will continue to work to give rural Medicare beneficiaries better
access to care and save the entire Medicare system precious dollars
so they can stay solvent and effective for generations to come.
These four bills will make it much easier for Medicare beneficiaries
to access and afford the care that they need, especially in rural
parts of the states.
I strongly encourage my colleagues to support these pieces of leg-
islation and help me bring them to the House floor.
I thank you, Mr. Chairman, and I will yield back.
Chairman TIBERI. Thank you, Ms. Jenkins. Representative
Marchant is recognized for five minutes.
Mr. MARCHANT. Thank you, Mr. Chairman. Thanks for having
this hearing and allowing us to put forward our ideas.
I introduced H.R. 3288 with my friend and colleague, Dr. Bou-
stany, last year. This legislation amends Title XVIII of the Social
Security Act to change the method of determining disproportionate
share hospital payments under the Medicare program. As the
members of this Committee are aware, DSH payments compensate
hospitals for the above-average operating costs they incur in treat-
ing a large share of low-income patients.
Mr. Chairman, 19 states have decided not to adopt Medicaid ex-
pansion. DSH hospitals in each of these states such as Texas, Flor-
ida, Tennessee, Kansas, and Georgia, are financially disadvantaged
by this. Though it is not our job to make state-level decisions, it
is our job to ensure our hospitals have the resources necessary to
care for our constituents.
My bill would help ease the burden these hospitals are facing.
Patient care is not a partisan issue, and I urge all of my colleagues
on this Committee to cosponsor this non-partisan, no-cost policy.
Mr. Chairman, once again I appreciate the effort being made
here today and for the forum to speak on ideas to sustain Medi-
care, and look forward to continuing to work with you and the com-
mittee to advance the policy and strengthen the DSH program.
15
Thank you, and I yield back.

Chairman TIBERI. Thank you, Mr. Marchant.
Representative Paulsen from Minnesota, you are recognized for
five minutes.
Mr. PAULSEN. Thank you, Mr. Chairman also for holding this
hearing. I have two bills that I have introduced that I would like
to touch on today that have bipartisan support and would benefit
seniors on Medicare.
The first is H.R. 5075, the Accelerating Innovation in Medicine
Act, also known as the AIM Act, which I introduced with Rep-
resentative Ron Kind. Currently, patients and providers are having
trouble accessing the newest, most innovative medical technologies
and more and more barriers and coming from CMS, rather than
from the FDA. And we, as a committee, need to take a serious look
at the CMS coding, coverage, and reimbursement process to exam-
ine how the agency is functioning, its impact on the biomedical eco-
system, and its effect on ensuring that patients will have access to
the next generations of advanced therapies.
Currently, the process of receiving a CMS code alone can take as
long as three years. National coverage decisions are typically time
consuming and cumbersome, and some new therapies must go
through a process of convincing each local carrier to provide cov-
erage before a patient or a senior can get access. This process
delays patient access to ground-breaking treatments.
My bill, the AIM Act, would focus on the front end of this process
by increasing patient access to the newto new FDA-approved
medical devices and procedures, and speeding up the collection of
data needed for Medicare coverage decisions. The AIM Act does
this by allowing a manufacturer to place FDA-approved devices
and treatments on a list, where they are available for Medicare
beneficiaries that self-pay.
By agreeing to not seek Medicare reimbursement for three years,
the devices then will be available without government red tape, pa-
perwork, and administrative costs. And during that three-year pe-
riod the manufacturer could collect patient data that will help
streamline a future Medicare coverage decision.
The current system is expensive, it is inefficient, and it gives pro-
viders, patients, and manufacturers uncertainty. And we need leg-
islation like the AIM Act so that we can ensure the continued de-
velopment of new treatments to improve Medicare outcomes, effi-
ciencies, and lower costs.
And then, Mr. Chairman, the second bill is H.R. 2404, the Treat
and Reduce Obesity Act that I have also introduced with Rep-
resentative Ron Kind. Obesity is now an epidemic and a public
health crisis that needs to be addressed. Over 40 percent of seniors
are obese. This disease takes both a physical and an emotional toll
on an individual, and often is the cause of many other chronic con-
ditions like diabetes, heart disease, stroke, and others.
Nearly 20 percent of the increase in our health care spending
over the last 2 decades was caused by obesity. And this disease di-
rectly costs Medicare more than $50 billion a year, and that num-
ber will continue to increase over the coming years. This is bad for
our seniors and it is bad for Medicare.
16
Unfortunately, there are limitations in place preventing patients

from accessing important treatments and providers that can help
them combat obesity. The Treat and Reduce Obesity Act would re-
move these barriers by giving patients access to FDA-approved obe-
sity drugs under Medicare Part D, and allowing additional quali-
fied health care practitioners to provide intensive behavioral ther-
apy services. Patients and clinicians require access to the full range
of proven, safe, and effective therapies for the treatment of obesity.
We have the ability to save the health care system billions of dol-
lars and, at the same time, make the lives of patients significantly
better. And that is why this bill has nearly 150 bipartisan cospon-
sors. We cant solve this problem overnight. But by taking action
now we will help us solve our obesity crisis over the long term.
And finally, Mr. Chairman, I just want to touch on another issue
that I am working on. I recently held a roundtable in Minnesota
with some hospitals, and they are concerned about the direction
that Medicare is going in terms of too much regulation, too many
requirements, and the reimbursement system being very unpredict-
able. Hospitals, providers, and patients all recognize that we need
fundamental reforms to the system. Otherwise, the system will col-
lapse and seniors will suffer.
Thankfully, there are providers, health plans, and states out
there that are now trying to find ways to make our health care sys-
tem more efficient and effective. They are not trying to tie the
health care system up in knots with duplicative process measures
that may or not yield the best results [sic]. But they are focusing
on outcomes, high impact, clinically credible outcomes that we can
focus providers around to achieve substantive and sustainable im-
provements for patients. And we can learn a lot from these state
and local initiatives to strengthen Medicare.
I look forward to working with you, Mr. Chairman, and my col-
leagues on those efforts to do just that. Those are just several of
the ideas that I have for reforming Medicare, and I look forward
to working with the chairman in the future on these bipartisan
ideas. I yield back.
Chairman TIBERI. Thank you, Mr. Paulsen. We are now to be
joined by members of the full committee who have some ideas of
their own on health care.
Welcome, everybody. How is it down there? Not bad?
Well, lets start with the gentleman to my far left, Mr. Dold.
You are recognized for five minutes to share your ideas with us.
STATEMENT OF THE HONORABLE ROBERT DOLD, A REPRE-
SENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
Mr. DOLD. Thank you, Mr. Chairman. I appreciate the com-
ments from my colleagues down hereyour comments.
[Laughter.]
Mr. DOLD. But anyway, Mr. Chairman, I thank you for the op-
portunity to testify before you today on two bills that I think will
make some critically necessary reforms to Medicare.
The first I would like to speak about is H.R. 5122, a bill that I
helped introduce alongside my colleagues, Dr. Bucshon, Dr. Bou-
stany, Dr. Price, and Representative Shimkus. This legislation
would prevent CMS from finalizing, implementing, or enforcing the
17
demonstration program they proposed on March 8th of 2016. The

proposal will dramatically alter the way Medicare Part B reim-
burses physicians for medications they administer to seniors in out-
patient settings. The resulting cuts could disrupt access to medica-
tions for our most vulnerable seniors, including those with cancer,
arthritis, and other very serious diseases.
As you are all aware, this proposed demonstration was developed
by the Center for Medicare and Medicaid Innovation with very lit-
tle transparency and limited input from patients and physicians.
Unlike previous CMMI demonstrations, all Part B providers are re-
quired to participate. As a direct result of the demonstration, by
phase two, 75 percent of all providers will see drastic cuts to their
reimbursements when providing Part B-covered medicines to pa-
tients.
It also appears that CMS has failed to fully model how this dem-
onstration will interact with other programs, especially the imple-
mentation of macro-legislation passed to repeal the SGR.
Thanks to the ingenuity and perseverance of incredible research-
ers, our modern medical system has moved away from a one-size-
fits-all treatment and has progressed into an era of precision medi-
cine where treatments are highly personalized for each individual
patient.
The proposed demo, or demonstration project, directly contradicts
this progress by incentivizing doctors to provide older, less ad-
vanced treatments, rather than newer, more innovative options. By
allowing this demonstration to proceed, we are putting physicians
in a very difficult position that not only is unfair, but detrimental
to patient care. This will be especially true for providers working
in small clinics serving rural areas.
When the Federal Government created Medicare 50 years ago,
Congress made a commitment to Americas seniors, and the cuts
embedded in this demonstration project are a betrayal of that com-
mitment. We must stop this ill-conceived proposal, and uphold our
commitment to protect health care for seniors.
I would also like to speak with you today about another bill that
will ensure seniors receive the best care possible. It is H.R. 1178,
the Ensuring Equal Access to Treatments Act, sponsored by my
friends, Representative Reed and Representative Kind. It improves
the way that CMS pays for certain diagnostic procedures that have
a discretionary drug component by altering the current one-size-
fits-all approach which does not allow seniors to receive the person-
alized care that best meets their needs.
In 2014 outpatient prospective payment system had a rule that
CMS redefined in terms of packaged payments for certain drugs
administered with corresponding procedure. Rather than reimburs-
ing for the drugs and the procedure separately, CMS now uses one
package payment, which includes the drugs and all other services
and supplies associated with the procedure.
Unfortunately, since the package payment is the same whether
or not the drug is used, the new payment structure has the effect
of encouraging health care providers to choose treatments which
may not result in the best long-term outcome for the patient. H.R.
1178 corrects the problem by requiring CMS to create two separate
18
payment codes, one for when the diagnostic procedure is performed

with drugs, and another when it is performed without drugs.
We have already seen cases where 2014 packaged payments is
negatively impacting vulnerable seniors. One example concerns the
diagnostic of coronary heart disease. Providers have two options to
raise a patients heart rate to a specific target: a stress test on a
treadmill or a stress test by an induced drug, which may be needed
for those that are unable to get on a treadmill to raise their heart
rate.
The current package payment system provides an incentive for
providers to choose the free treadmill test over the drug, even if the
drug may be more appropriate. I believe we have an obligation to
correct this misaligned incentive, so that patients receive the most
appropriate care necessary. We have seen a similar problem when
physicians choose whether to diagnose bladder cancer with the
new, innovative procedure known as a blue light cystostopy, or an
older, less advanced white light test.
We made a commitment to provide Americas seniors with high-
quality health care through Medicare programs. I look forward to
working with all of you on H.R. 5122 and H.R. 1178, and the other
bills that have been presented here today, in order to ensure that
we maintain our commitment to our seniors.
I thank you.
Chairman TIBERI. Thank you, Mr. Dold. Thank you for your
leadership in trying to stop that Part B demonstration program
being proposed. It is important for us to try to do that. Look for-
ward to working with you in that attempt.
With that, Sheriff Reichert, you are recognized for five minutes.
STATEMENT OF THE HONORABLE DAVID G. REICHERT, A REP-

RESENTATIVE IN CONGRESS FROM THE STATE OF WASH-
INGTON
Mr. REICHERT. Thank you, Mr. Chairman. And I want to thank
Chairman Tiberi and Ranking Member McDermott for being here
today and holding this hearing and listening to our initiatives that
we have been working on. I would like to talk about a couple of
bills.
First I would like to talk about H.R. 2649. And this bill was in-
troduced with Representative Mike Thompson, and it is assisting
Medicare beneficiaries who have been injured on the job, filed a
claim for workers compensation, and settled their claims. In these
settlements an amount must be set aside to cover Medicares share
of future medical expenses related to the injury.
The problem is that there are no statutory or regulatory provi-
sions defining how these set-aside amounts should be determined.
And the current procedure used by CMS has been subject to
change without reasonable notice to the parties involved. This bro-
ken process results in delays and hardships for injured workers.
My bill establishes a clear, predictable process. A few ways it ac-
complishes this is by setting up timeframes for CMS to review set-
asides, providing an appeals process and also offering individuals
the option to pay the total set-aside amount directly to CMS.
19
So I look forward to working with you on this bill in advance. It

is one of the priorities that we have been discussing, both on the
D and the R side.
The next bill is one that, Mr. Chairman, you and I have talked
about. It is the Lymphedema Treatment Act. This is 1608. I intro-
duced this bill with Mr. Blumenauer. Lymphedema causes painful
swelling in parts of the body where the lymph nodes or vessels
have been damaged. While there are many causes, damage from
cancer treatment is probably the most common. While there is no
known cure for lymphedema, it is treatable.
But sadly, Mr. Chairman, current Medicare law leaves patients
without access to treatment items they need to manage the swell-
ing and prevent further health complication. My bill will fix this
by providing coverage of doctor-prescribed compression supplies.
This will not only save lives, but improve patients health. But it
also will strengthen Medicare program by reducing costly hospital
stays.
For example, Sarah from Ohio. When she was diagnosed with
lymphedema she was on the verge of losing her mobility and suf-
fered frequent episodes of cellulitis. Between 2002 and 2004 she
was hospitalized more than 10 times. In 2005 she was prescribed
her first pair of compression garments. And by wearing these gar-
ments on a daily basis, she was able to maintain the progress she
has made through treatment, manage her lymphedema so well that
she has not been to the hospital in over a decade. In over a decade.
Bob, from New York. In 2000 he was hospitalized twice with po-
tentially fatal cellulitis infections. Later that year he was diag-
nosed with lymphedema. He received treatment and was prescribed
the compression garments. In the 16 years since he has not had an-
other cellulitis attack and has not been to the hospital.
Now, we can talk about whether or not this is expensive, because
that is what, of course, the Administrations argument is, and
Medicares argument is. But we are saving a lot of money by pro-
viding these garments to these patients who have suffered through
and survived cancer, saving money at the back end on other treat-
ments and hospital stays. And not only that, it is the right thing
to do for these patients.
So I want to thank Members here today who have already co-
sponsored this bill. I would like to recognize the patient advocates
who have taken the time to meet with their Members and share
their stories. Thanks to their tireless efforts, the bill now enjoys,
Mr. Chairman, over 230 bipartisan cosponsors. And now we are
working to even get more.
And I ask, Mr. Chairman, unanimous consent to enter into the
record a statement from the lymphedema advocacy group.
Chairman TIBERI. Without objection.
Mr. REICHERT. The bottom line here is these are not defined
by Medicare as medical devices because they dont fall within the
definition of long-term, durable devices, which is three years, be-
cause in most cases the patients have to have new garments every
six months. They are not disposable medical devices because they
keep them six months and not a few weeks or a few days. This is
ridiculous, a ridiculous rule, Mr. Chairman, and this bipartisan
20
piece of legislation changes this rule and helps these patients get
the treatment they so desperately need.
Thank you, I yield back.
Chairman TIBERI. Thank you, Sheriff. Now, representing the
entire South Dakota delegation in the House, Representative Kristi
Noem.
Mrs. NOEM. That is a big job.
Chairman TIBERI. Thank you for being here.
STATEMENT OF THE HONORABLE KRISTI NOEM, A REPRE-
SENTATIVE IN CONGRESS FROM THE STATE OF SOUTH
DAKOTA
Mrs. NOEM. Thank you, Mr. Chairman. And thank you Ranking
Member McDermott and Members of the Subcommittee, for holding
this hearing and allowing me to talk about a Medicare bill that I
am promoting.
I am here to discuss H.R. 4277, the Medicare Mental Health Ac-
cess Act. I introduced this bipartisan bill with my Democratic rep-
resentative, Jan Schakowsky, who has been a leader on mental
health care policy. She is a member of the E&C committee. And I
want to thank her and her staff for all of their hard work on this
issue, as well.
As you know, millions of Americans lack adequate access to men-
tal heath services. And it is especially true for thousands of seniors
who age into Medicare every day. The Federal Government should
be working to improve access for these individuals. But sadly, cur-
rent law does exactly the opposite. In fact, it presents significant
barriers to American seniors who seek mental health services.
The problem is that seniors have to go through a middle-man to
get care, and that is because Medicare requires that many services
provided by clinical psychologists must be prescribed and mon-
itored by a medical doctor, a doctor who may or may not have any
experience or training in mental health care. This supervision re-
quirement is outdated and it stands in stark contrast to the private
sector, in which clinical psychologists are largely allowed to provide
treatment independently.
That requirement also fails to respect clinical psychologists rig-
orous training and licensure requirements, which includes years of
study in obtaining a Ph.D. This requirement is especially harmful
for rural and under-served areas like South Dakota. When a physi-
cian is not available to oversee a clinical psychologistss treatment
program, the services are simply not offered.
My bill, H.R. 4277, makes it easier for seniors to obtain mental
health care services that they need, and it puts clinical psycholo-
gists on equal footing with other non-physician providers like chiro-
practors and optometrists. They are easily accessible by Medicare
beneficiaries.
In short, the Medicare Mental Health Access Act amends Medi-
cares definition of physician. It includes clinical psychologists.
This would have the effect of removing the middle-man from the
process of seeking mental health services and allowing seniors to
go directly to clinical psychologists.
It is also important to note that, while this adds clinical psy-
chologists to the physician definition, it would not allow clinical
21
psychologists to become medical doctors. Rather, it would simply

allow them to practice in a more independent way by removing
that physician supervision requirement.
I would like to thank Mr. Nunes, Mr. Kind, Mr. Blumenauer, the
subcommittee members who have already cosponsored this impor-
tant bill. I urge the rest of you to join them because the Medical
Mental Health Access Act represents a huge opportunity for us. It
will tear down barriers for mental health care access for our sen-
iors where, in states like South Dakota, we see it being a real issue
for them getting the kind of care that they need.
I sincerely hope the committee will take up this bill as soon as
possible. And again, Mr. Chairman, I thank you for the opportunity
to testify today.
Chairman TIBERI. Thank you for your leadership on these im-
portant issues.
Mr. Renacci, thank you for your leadership on the readmissions
issue that became part of a bill that we passed unanimously on the
floor last night. And we recognize you for five minutes.
STATEMENT OF THE HONORABLE JIM RENACCI, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO
Mr. RENACCI. Thank you, Mr. Chairman, for holding this hear-
ing. I am grateful for the many bills that my colleagues have and
will present today. Indeed, I am a proud cosponsor of many of
them. I also think it is important we are here today presenting pro-
posals, and continuing the conversation on how we can improve the
delivery of services through Medicare and health care systems in
general.
When it comes to seniors, for instance, too often they decide not
to seek the care they need because of the price, the inconvenience,
or the bureaucratic red tape which gets in the way. There are so
many burdensome and confusing regulations which many times
leave Medicare beneficiaries waiting for a level of care they need
or potentially facing extremely large bills they thought Medicare
was covering.
For example, under current Medicare payment policy, even if a
physician knows the proper care setting for a beneficiary is a
skilled nursing facility, beneficiary must be admitted to a hospital,
stay at least three days as an inpatient, in order for Medicare to
cover the cost of the beneficiarys stay in a skilled nursing facility.
Many times the beneficiarys personal doctor is also on staff at that
same hospital, and certainly knows the level of care needed before
they are admitted.
Even more concerning is that often times patients are not actu-
ally admitted as an inpatient, and are only admitted under obser-
vation stay. Despite most not knowing their status, most bene-
ficiaries actually see no difference in care while at the hospital, but
are penalized for non-payment if later admitted to a skilled facility.
Unlike other post-acute care settings, Medicare requires a three-
day inpatient hospital stay to qualify for skilled care, causing con-
fusion for beneficiaries. According to an OIG report in 2012, bene-
ficiaries had over 600,000 hospital stays that lasted 3 nights or
more, but did not qualify them for skilled nursing facilities, mean-
ing these individuals were either outpatient or observation status
22
during the hospital stay. Because they did not have the three days
of inpatient care, as confusing as it sounds, they did not qualify for
skilled nursing care, due to the inpatient requirement, and they
are left incurring tens of thousands of dollars of costs that are not
reimbursed by Medicare if they end up going to a skilled facility.
In order to protect access to rehabilitation services, I have intro-
duced a bipartisan bill, H.R. 290, the Creating Access to Rehabili-
tation for Every Senior. It is called the CARES Act. It waives the
three-day inpatient stay requirement for skilled nursing facilities
that meet certain quality measures.
Here is an interesting fact. The average three-day inpatient hos-
pital stay in many cases is equal to or sometimes more costly than
the average 27-day stay in a skilled nursing facility. And we bur-
den our Medicare system with both levels of cost. Even private in-
surance companies have already eliminated this unnecessary and
duplicative expense, the three-day requirement.
Therefore, by eliminating the three-day inpatient requirement,
Congress can save both the beneficiary and the Medicare system
money by reducing unnecessary hospitalizations.
I understand this issue. I operated skilled nursing facilities for
over 28 years. Just like many of the bills that passed the full
House yesterday, I believe this is one more common-sense reform
which will minimize hospital over-utilization, cut down on unneces-
sary red tape, eliminate unnecessary costs to Medicare program,
and focus on what is best for the patient.
Why should a beneficiary have to go to a hospital, have a doctor
diagnose the need for nursing home care, all while remaining in
the hospital, costing the system thousands of dollars? The CARES
Act fixes this one step, lets doctors decide the best care delivery
system without burdening the cost of a three-day hospital stay, and
helps protect the solvency of Medicare.
And I look forward to working with my colleagues on both sides
of the aisle to try and move this legislation. Thank you, Mr. Chair-
man, and I yield back.
Chairman TIBERI. Thank you, Mr. Renacci.
Dr. Boustany, you are recognized for five minutes. Thanks for
your leadership in health care.
STATEMENT OF THE HONORABLE CHARLES BOUSTANY, A

REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOU-
ISIANA
Mr. BOUSTANY. Thank you, Mr. Chairman. I want to thank you
and fellow members of the Ways and Means Committee, the Health
Subcommittee, for holding this hearing and for hearing our prior-
ities through a regular legislative order. I think this is really im-
portant, and especially with an emphasis now on strengthening the
Medicare program, which is a vital program.
As you all know, the Medicare program was established in 1965
to provide reliable health coverage for Americas seniors, and we all
know there are significant challenges ahead to preserve and
strengthen this program. And I am convinced that we cannot really
truthfully and effectively solve the problems with Medicare unless
we fully embrace innovation and the latest technology that comes
23
online to improve the health and the lifespan and the quality of life
for our seniors.
I could tell you, as a long-time practicing cardio-vascular sur-
geon, I saw an explosion of new technology, just in the time I was
in practice, that made major differences, huge differences in the
lives of seniors, and that continues today.
I am proud to join my Ways and Means colleague, Richie Neal,
as well as colleagues on the Energy and Commerce Committee, Gus
Bilirakis and Tony Cardenas, to introduce H.R. 5009, called the
Ensuring Patient Access to Critical Breakthrough Products Act.
This legislation provides an accelerated route to FDA approval and
subsequent limited coverage under Medicare in order to stimulate
the development of important new diagnostics and treatments that
address currently unmet medical needs.
For instance, following FDA approval it can take upwards of
three years to receive a reimbursement code under Medicare, de-
laying patient access to groundbreaking technology. This is just un-
acceptable. We can do better. And while this legislation continues
to allow CMS to remain the final arbiter for extending permanent
coverage of this limited universal medical device technology, this
legislation is a very important step to enhancing access on the
front end to this cutting edge diagnostic and treatment technology
for Americas seniors.
Many examples exist. I have talked to a number of our compa-
nies, particularly the heart valve technology arena, where they
move to advance technology nowfor instance, instead of having to
cut open the chest and spread the ribs and the sternum, they can
do this through percutaneous technology to save lives and mor-
bidity, and truly help people who might not have even been can-
didates for open heart surgery because of other existing co-
morbidities. That is just one example of the many advances.
But if we are caught whereby, after going through a lengthy FDA
process CMS delays the implementation and the use of this tech-
nology because there is no reimbursement code, then, I mean, this
technology sits there and it is not accessible for seniors.
This legislation is a modest approach to addressing this logjam
and helping to move this technology forward, and so I look forward
to working with the committee, and hope we can mark up this bill.
Thank you, Mr. Chairman, I yield back.
Chairman TIBERI. Thank you, Dr. Boustany, for your leader-
ship. With that, the gentleman from New Jersey, my friend, Mr.
Pascrell, a member of the subcommittee, is recognized for five min-
utes.
STATEMENT OF THE HONORABLE BILL PASCRELL, A REP-
RESENTATIVE IN CONGRESS FROM THE STATE OF NEW JER-
SEY
Mr. PASCRELL. Thanks, Mr. Chairman, and thanks for putting
this together. There are some things we disagree with, there are
a lot of things we do have in common, though. So today I want to
touch three subjects, if I may.
Huntingtons Disease Parity Act, H.R. 842, the Huntingtons Dis-
ease Parity Act, with my friend, Congressman Adam Kinzinger
from Illinois. Today the bill has 253 bipartisan cosponsors, 15 from
24
our committee alone, and of itself, makes this bill, I think, worthy
of consideration.
Huntingtons Disease, or HD, is a genetic neuro-degenerative dis-
ease that causes total physical and mental deterioration over a 10
to 25-year period. Because it is a genetic disorder, HD profoundly
affects the lives of entire families emotionally, socially, financially,
like a lot of other diseases, too. This devastating disease has no
treatment or cure, and slowly diminishes an individuals ability to
walk, to talk, to reason.
Today I will focus on the one provision of the bill which would
waive the two-year Medicare waiting period for individuals with
HD. Under current law, once a person with HD is deemed eligible
for disability benefitswhich is a challenge in itselfthey are then
forced to wait two more years before they can receive Medicare
benefits. This means that while people are in the grips of a terrible,
all-consuming, degenerative disease they can often not access the
range of health care services they desperately need. This is simply
unacceptable, Mr. Chairman.
I thank all of my colleagues on the Ways and Means who joined
with me on this legislation.
Second thing is Reserving Patient Access to Post-Acute Hospital
Care Act. I would like to highlight H.R. 4650, the Preserving Pa-
tient Access to Close Acute Hospital Care Act, which I introduced
with my friend, Congressman Vern Buchanan. As the co-founder
and co-chair of the Congressional Brain Injury Task Force, I under-
stand the important role that long-term care hospitals play in the
recovery of many individuals who suffer moderate to severe trau-
matic brain injuries, or TBIs.
If there is one thing that I have learned about TBI in the 16
years I have been working on this issue, it is that recovery looks
different for everyone. That is why we must preserve access to all
post-acute care options, so patients can receive the individualized
care that they need.
H.R. 4650 would provide an additional 2 years of relief from the
full implementation of the 25 percent rule for long-term care hos-
pitals. I would also note that the industry has offered to extend the
current moratorium for a long-term care hospital to help offset the
cost of the bill, which is something that I hope the committee
would consider.
And my final point is this, Mr. Chairman, something you have
heard me speak about too many times, probably, and that is the
UDI and claims. More than a few times. I just want to touch briefly
on it being included in the unique device identifiers, the UDIs, in
health insurance claims.
This is an important patient safety measure that would improve
post-market surveillance of medical devices to help identify prob-
lems with devices more quickly and help improve Medicare pro-
gram integrity. I was very pleased last month when CMS Acting
Administrator Andy Slavitt expressed support for the important
policy.
I look forward to working with you, Mr. Chairman, Mr. Ranking
Member, to get this done. And I thank you, and I yield back, Mr.
Chairman. Thank you.
25
Chairman TIBERI. Thank you, Mr. Pascrell. We will go from Jer-

sey to Philly.
Representative Meehan, you are recognized for five minutes.
Mr. MEEHAN. It is a great route, isnt it, Mr. Pascrell?
STATEMENT OF THE HONORABLE PATRICK MEEHAN, A REP-
RESENTATIVE IN CONGRESS FROM THE COMMONWEALTH
OF PENNSYLVANIA
Mr. MEEHAN. Thank you, Mr. Chairman and the full com-
mittee, for your participation and allowing us to take this oppor-
tunity. And I appreciate the opportunity to speak about H.R. 4212,
which is the Community-Based Independence for Seniors Act of
2015, which I introduced with our colleague, Representative Linda
Sanchez.
The bill would authorize community-based institutional special
needs plan demonstration program to provide home and commu-
nity-based long-term services and supports to low-income Medicare
beneficiaries who need assistance with at least two activities of
daily living.
Under current law, Medicare does not typically provide coverage
for community-based, long-term care services and supports, which
include medical and personal care, such as assistance with bathing
or managing medications. And one study found that 13 percent of
seniors spent down their savings in order to qualify for Medicaid.
The demonstration program is designed to eliminate the need for
Medicare beneficiaries who receive a low-income subsidy to spend
their savings and become dependent on Medicaid. Many seniors
prefer to remain in their homesin fact, they are more healthy as
a result of itto receive the care that they need. And home and
community-based care holds the promise of keeping seniors healthy
and avoiding costly care.
The demonstration offers up to five Medicare Advantage plans to
provide coverage for long-term care services. The plans will receive
a per-month payment not to exceed $400 for providing these serv-
ices, and eligible Medicare beneficiaries with CBI in their area
have the option to enroll in the plan.
HHS will evaluate whether providing home and community-
based services to Medicare beneficiaries reduces state and Federal
Government health care spending through delaying Medicaid eligi-
bility for low-income seniors and reducing the need for acute care.
The demand for long-term care services and supports continue to
increase. The population of seniors 85 years and older is estimated
to more than triple by 2050, and this group is 4 times more likely
to use long-term services and supports compared to seniors age 65
to 84.
This program is one step towards reforming long-term service
and supports that can generate savings while allowing seniors to
remain healthy at home. A similar version of my legislation was re-
ported out of the Senate Finance Committee last year, and I ask
for the Chairmans support in advance of H.R. 4212.
I also want to highlight the arbitrary and capricious manner in
which CMS is making decisions regarding eligibility to participate
in Medicare programs as a hospital. CMS must not establish or
change a substantive legal standard governing the eligibility of or-
26
ganizations to furnish services or benefits, unless the agency uses

notice and comment rulemaking. However, CMS has done just that
in a ruling that will make a determination that Wills Eye Hospital
is not eligible to participate in Medicare as a hospital.
In contrast, the Pennsylvania Department of Health in the state
of Pennsylvania, the survey agency determined that the hospital
satisfied the Medicare conditions of participation and should be li-
censed under Pennsylvania laws an inpatient hospital. And I ask
the chairman to work with me to ensure that CMS is using known
standards in making determinations regarding hospital status for
purposes of the Medicare reimbursement.
And lastly, I want to note that I am working with Ranking Mem-
ber McDermott on the Beneficiary Enrollment Notification and Eli-
gibility Simplification Act, also known as the BENES Act. And as
many of you know, Medicare enrollment rules are complex, and
seniors do not receive notice from CMS regarding their responsi-
bility to enroll. And because of these confusing rules, seniors may
find themselves subject to a late enrollment penalty.
The Part B late enrollment penalty permanently increases a
beneficiarys premium by 10 percent for every 12-month period the
beneficiary could have had Part B coverage but did not. Others are
paying for private coverage that is a secondary coverage to Medi-
care. But without enrolling in Medicare, these seniors will find
themselves responsible for significant out-of-pocket costs. Part of
the solution is to require CMS, in cooperation with the Social Secu-
rity Administration and the IRS, to issue notifications to individ-
uals approaching eligibility about the enrollment rules and the co-
ordination of Medicare coverage with other health insurance cov-
erage.
I appreciate the consideration of my colleagues, and I thank you,
Mr. Chairman.
Chairman TIBERI. Thank you, Mr. Meehan.
Welcome to the Ways and Means Committee room, Mr. Mooney
from West Virginia. You are recognized for five minutes.
Turn on yourthank you.
STATEMENT OF THE HONORABLE ALEX MOONEY, A REP-

RESENTATIVE IN CONGRESS FROM THE STATE OF WEST
VIRGINIA
Mr. MOONEY. All right. There you go. Thank you, Mr. Chair-
man. I do appreciate the opportunity to testify about my bipartisan
bill, the Promoting Responsible Opioid Prescribing Act, or the
PROP Act.
My home state of West Virginia has the highest rate of opioid
overdose deaths in the country, more than double the national av-
erage. This drug abuse epidemic is a tragedy crying out for action.
Addictions ravage our communities, rips families apart, stunts the
development of our youth, and harms our economy.
The House has already taken some important steps to address
this epidemic, but much more remains to be done. One solution is
my bipartisan bill, the PROP Act, H.R. 4499. This bipartisan bill
removes a harmful provision of the Affordable Care Act that places
unnecessary pressure on doctors and hospitals to prescribe narcotic
27
pain medication, regardless of whether the patient actually needs

it.
This problem was first brought to my attention by a group of doc-
tors in Charleston, West Virginia, and I thank them for that. These
doctors, many of whom serve Medicare patients, describe the di-
lemma they face when treating pain: either prescribe narcotic pain
medicine to patients who do not need it, or risk receiving a low pa-
tient satisfaction score and a subsequent cut to the reimbursement
rates. This dilemma is a result of a well-intentioned policy that is
having unintended negative consequences.
In 2006 the Center for Medicare and Medicaid Services, CMS,
and the Department of Health and Human Services, HHS, devel-
oped a survey called the Hospital Consumer Survey of Health
Care Providers and Systems. We know it as HCAPS. HCAPS is a
standardized survey used to measure patient perspectives and sat-
isfaction on the care they receive in hospital settings. At first hos-
pitals used this survey on an optional basis. However, when the Af-
fordable Care Act became law in 2010, it put in place paid per-
formance provisions that use these survey results as a factor in
calculating Medicare reimbursement rates for physicians and hos-
pitals on quality measures.
The survey includes three questions related to pain management,
including one that asks whether patients feel that their caretakers
did everything they could to help with pain. While these ques-
tions are clearly intended to help patients, doctors tell me that
these questions pressure the doctors to over-use prescription pain
narcotics when treating patients.
At a time when prescription pain abuse is rampant, this is deep-
ly concerning. Doctors, not the Federal Government, know best how
to treat patients. And that includes the question of how best to use
narcotic pain medicine. The PROP Act would remove the three pain
management questions from consideration only when CMS is con-
ducting reimbursement analysis. However, the patient will still an-
swer the pain management questions in the HCAPS survey, so hos-
pitals can monitor how they are doing.
By severing the relationship between HCAPS question on the
pain management and reimbursement, we can remove undue pres-
sure on doctors to prescribe unnecessary opioid medications. This
simple change will reduce access to narcotic pain medication for pa-
tients who do not need it, thereby reducing the risk of addiction.
According to the National Institute on Drug Abuse, people who
abuse opioid pain killers are 19 times more likely to start using
heroine than people who do not abuse those painkillers.
In addition, CMS is fully able to implement the PROP Act. The
agency has already provided my staff and this Committee with
technical assistance on the bill. If the bill passes, CMS will simply
remove the questions from reimbursement calculations during the
next rulemaking session. I would like to thank the staff from this
Committee for their help with that.
The PROP Act is also broadly supported by groups active in this
field, including the American Hospital Association, the American
Medical Association, Physicians for Responsible Opioid Prescribing,
Association of American Medical Colleges, and Americas Essentials
Hospitals. It has also been introduced in the Senate by Senators
28
Johnson, Manchin, Capito, Barrasso, Blumenthal, Markey, Toomey,

Ayotte, and King.
Finally, I want to thank many members of the Ways and Means
Committee who are already cosponsoring the PROP Act: Tom Price,
Diane Black, Tom Rice, Pat Meehan, Earl Blumenauer, and Bill
Pascrell.
Thank you, Mr. Chairman, for your consideration.
Chairman TIBERI. Thank you, Mr. Mooney, for your leadership
on the PROP Act. It is one that I have heard about, too, back in
my district in Ohio, as we have talked about. So I look forward to
working with you.
Mr. MOONEY. Thank you.
Chairman TIBERI. Thanks for being here.
Mr. MOONEY. Sure.
Chairman TIBERI. Before I turn to Mr. Larson for five minutes,
I wish to inform him that a member of this Subcommittee was
going to object to you being here, but I dont see him right now.
So be prepared if he comes back in the room.
Mr. CROWLEY. Mr. Chairman? Mr. Chairman?
Chairman TIBERI. Mr. Crowley?
Mr. CROWLEY. On behalf of Mr. Pascrell, I would like to object.
[Laughter.]
Chairman TIBERI. Mr. Larson, you are recognized for five min-
utes. Can you turn on your microphone? Thank you.
Mr. LARSON. I thank the chairman for interceding on my be-
half. We were just on one of Mr. Pascrells shows.
Chairman TIBERI. I heard.
Mr. LARSON. He is perplexed after that show.
STATEMENT OF THE HONORABLE JOHN LARSON, A REP-
RESENTATIVE IN CONGRESS FROM THE STATE OF CON-
NECTICUT
Mr. LARSON. So, in keeping with the spirit of the meeting, let
me first start by thanking Cathy McMorris Rodgers, as well as our
colleagues, Tom Reed and Kurt Schrader, on introducing H.R.
3244, which is Providing Innovative Care for Complex Cases Dem-
onstration Act of 2016.
Mr. Chairman, this bill would create a demonstration program in
Medicare that would allow for contracts in several different parts
of our country to be awarded with either a high-quality Medicare
Advantage plan or physician organization ACO to provide an inno-
vative care plan for the highest cost Medicare beneficiaries in this
area.
As the chairman knows more keenly than most, that the hardest-
to-serve population at the end of stages in their life is the most
costly that we face, in terms of the Medicare programs that serve
this nation so well. What this bill does, in short, is to provide more
benefits, lower out-of-pocket costs, provide an integrated care
model, and set high-quality standards.
What it does, in short, too, Mr. Chairman, is something I believe
this Committee should always subscribe to, and that is combining
the very best that public health and the government side of the
ledger can bring to bear, along with the innovation and technology
of the private sector and academic research organizations that we
29
have to lower the cost of health care in a way that is most efficient
and productive.
It is no mistake that when we were looking at the Affordable
Care Act that there is somewhere between 700 and $800 billion an-
nually in fraud, abuse, and overlap of responsibilities that take
place within the health care system. This can be eliminated.
We know this can happen, in large part, because of, well,
innovators like the Aetna in my district, in Hartford, Connecticut,
where we are fortunate to have an individual who is the CEO who
is a visionary and way ahead of his time, a person who recognizes
that what we want to do is make sure that we are able to keep
people in their own homes, that they are able to stay there and
provide for the needs. It is a place that they all want to be.
And in the process, if we can keep them out of the hospital, no-
body wants their loved one to acquire a staff infection while in the
hospital. Nobody wants to have to be readmitted after a hospital
stay because of a lack of follow-up care. No one who has a loved
one with a chronic health condition like heart disease or diabetes
wants their health to be compromised because of a lack of coordina-
tion amongst health care providers.
What this bill will do is provide innovations. What it will provide
is an opportunity for us to keep people in their homes in an inte-
grated fashion by coordinating their care in a systemic manner
that will allow us to impact the cost and also provide the patient
with the best possible outcomes, Mr. Chairman.
I am proud to be a sponsor of this, and I think this is a prime
example of how we can work together across the aisle by sharing
the vitality of ideas in everything that technology and innovation
and, frankly, that the public health system can bring to bear. And
then, from a human standpoint, recognizing what the citizen and
what the people want. In the final stages of life they want to be
in their homes. And we ought to be able to come up with the inno-
vation and way to do it.
Mark Bertolini, the CEO of the Aetna, recognizes this and is one
of the leading thought thinkers with respect to innovative health
care designed to reduce these costs so we get away from the near
20 percent of our gross domestic product that health care ends up
costing.
So, Mr. Chairman, I again want to congratulate my cosponsors,
especially Cathy McMorris Rodgers, our colleague, Tom Reed, and
also Mr. Schrader for their support of this bill, and I thank you for
the opportunity to testify before your committee, and hope it will
be taken up during this brief session.
Chairman TIBERI. Thank you. I thank the gentleman from Con-
necticut. I have heard a little about that. Aetna has a large pres-
ence in Ohio. And I am kind of surprised that you promoted a gen-
tleman with an Italian last name as being intelligent and
thoughtworthy.
Mr. LARSON. Well, unlike Mr. Pascrell, he has a vowel at the
end of his name.
[Laughter.]
Mr. LARSON. But thank you, Mr. Chairman.
Chairman TIBERI. I thank the gentleman. The gentleman from
New York is recognized for five minutes.
30
STATEMENT OF THE HONORABLE JOSEPH CROWLEY, A REP-
RESENTATIVE IN CONGRESS FROM THE STATE OF NEW
YORK
Mr. CROWLEY. I believe Mr. Pascrell also objected to my testi-
mony today, as well. So on his behalf I would like to object to my
testimony. But thank you, Mr. Chairman and Mr. McDermott, for
this opportunity to join you today as we hear proposals to strength-
en the Medicare program.
I am glad to have the opportunity to talk about legislation I put
forward to address what must be a priority within the Medicare
program: training the doctors we need to meet the health care
needs for tomorrow. And I thank Mr. Davis, who I believe spoke
earlier about this particular bill.
This is not something we could take lightly. Estimates indicate
that by 2025 we will have a shortage of up to 95,000 doctors, both
primary care doctors and specialists in the United States. Our
health care needs are only growing, with a greater importance on
preventative care and comprehensive health in an aging popu-
lation. Ten thousand Americans turn 65 every day, so it is clear we
need to have doctors available to treat them and Americans of all
ages.
Important steps have been taken. Medical schools have worked
to increase their enrollment and their graduating classes. But what
a lot of people dont realize is that once those students graduate,
they need to complete another stage of training by doing a resi-
dency program at one of the nations teaching hospitals. Without
completing their residency, they cannot become licensed to practice
medicine.
Unfortunately, growing numbers of smart, well-prepared medical
school graduates are fighting for a stagnant number of residency
slots. We are not just facing a physician shortage, we are facing a
physician bottleneck.
But there is a clear path forward. For generations, training doc-
tors has been a shared responsibility of the Federal Government
and teaching hospitals, and that is because it is a shared benefit.
The whole country benefits from more well-trained doctors. Con-
gress has long recognized the value of investing in doctor training.
And as a result, the Medicare program helps to support doctor
training programs by funding residency slots around the country.
However, there was an arbitrary cap on the number of residency
slots that Medicare will support. And this cap hasnt been raised
in nearly two decades. Teaching hospitals have done their part in
stretching their funds as far as they can go to help fund additional
residency positions, even beyond that which Medicare covers. But
they cannot do this alone. We must act and act soon to raise the
Medicare cap on residency slots.
There is no way to create more doctors overnight, but we can
make the changes now that will open up the doctor training pipe-
line. I have put forward bipartisan, common-sense legislation, the
Resident Physician Shortage Reduction Act, to increase the number
of Medicare-supported residency slots by 15,000 over 5 years. And
I am pleased to have been joined in this effort by Dr. Charles Bou-
stany, a member of this Committee, and someone who I think all
31
of us respect for his experience. After all, who better to stress the
importance of medical training than a cardio-vascular surgeon?
Over 125 Members of the House, including many members of
this Committee, have joined us as cosponsors of this bill. This bill
would further address our doctor shortage issues by directing half
of the new slots to go to specialists that are determined to be run-
ning a shortage. And it makes a decisive statement that we need
to make a strong investment in our doctor training program. That
is particularly important if we should seek continued proposals to
cut or weaken the impact of graduate medical education funding.
Far from being a luxury, teaching hospitals depend on this fund-
ing to fulfill their mission. It is an investment, not just in dollars
and cents of running a teaching hospital, but in the highly complex
and costly patient care missions that teaching hospitals undertake.
They run advanced trauma centers and burn units. They see more
complex patient cases. They treat patients with rare and difficult
disease, like Ebola. And that helps train future doctors in all those
areas.
Graduate medical education payments were designed by Con-
gress to reflect and encourage and reward all those efforts. And in
a time of changing health care, teaching hospitals are doing more
to train residents in community care settings and to give residents
the skills for exactly the kind of coordinated care that our system
is moving toward. So I urge all my colleagues on the committee to
allow our teaching hospitals to continue to thrive in the mission of
training the next generation of physicians. That means maintain-
ing our investment in graduate medical education funding.
And in what I hope will be a priority for this Committee, it
means lifting the outdated cap on residency slots, Mr. Chairman.
It is not exaggerating to say the future of our health care system
depends on just that.
And with that I yield back.
Chairman TIBERI. Thank you, Mr. Crowley. I appreciate your
testimony today and bringing the matter to our attention.
We will stay in the State of New York and recognize and wel-
come to the committee room, the Ways and Means Committee
room, Mr. Zeldin for five minutes.
STATEMENT OF THE HONORABLE LEE ZELDIN, A REPRESENT-

ATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. ZELDIN. Thank you, Mr. Chairman. And thank you for the
opportunity to present my bill, H.R. 3229, to provide for the non-
application of Medicare competitive acquisition rates to complex re-
habilitative wheelchairs and accessories, an important piece of leg-
islation which would have a significant impact on individuals with
severe disabilities.
Complex power and manual rehabilitative wheelchairs and re-
lated accessories are mostly utilized by a small percentage of indi-
viduals who suffer from significant disabilities such as ALS, cere-
bral palsy, multiple sclerosis, muscular dystrophy, spinal cord in-
jury, traumatic brain injury, and many more. Within the Medicare
program these individuals represent less than 10 percent of all
Medicare beneficiaries who use wheelchairs, making them an ex-
32
tremely vulnerable group of people suffering from significant dis-

abilities.
The specialized equipment these individuals rely upon for daily
life is provided through a clinical team model and requires evalua-
tion, configuration, fitting, adjustment, or programming before it
can be properly used. This small population of individuals has the
highest level of disabilities and requires these individually-config-
ured wheelchairs and critical related accessories to meet their med-
ical needs and maximize their function in independence.
In 2008 Congress passed and the President signed into law the
Medicare Improvements for Patients and Providers Act, MIPPA,
which established a fixed price schedule for complex rehab tech-
nology, CRT, and related accessories. Under MIPPA, CRT devices
would be excluded from CMSs competitive bidding program to en-
sure consistent and fair prices for consumers. Excluded devices in-
clude power wheelchairs and related accessories, which are the fun-
damental parts of the products that make them useful and bene-
ficial to people with progressed disabilities such as recline tilt sys-
tems, specialty controls, and seatback cushions.
In November 2014, however, CMS issued a ruling contrary to
MIPPA which stated that, beginning in January of 2016, acces-
sories that are used on complex rehabilitative wheelchairs will no
longer be a part of the fixed-fee schedule, but will now be subject
to competitive bidding prices, which will decrease access to the in-
dividually-configured wheelchairs and accessories relied on by
adults and children with disabilities.
While Congress acted to temporarily delay this measure until
2017, further action is needed to permanently address this issue.
My legislation, H.R. 3229, seeks to codify the 2008 MIPPA regula-
tions, and excludes power and manual wheelchairs and their re-
lated accessories from the competitive bidding process.
In addition to the significant support from groups such as the
ALS Association, Muscular Dystrophy Association, National Mul-
tiple Sclerosis Society, Paralyzed Veterans of America, Vets First,
the United Spinal Association, and the Christopher Reeve Founda-
tion, just this past week the Government Accountability Office
issued a report to Congress regarding the benefits of this legisla-
tion. This GAO report focused on utilization expenditures for Medi-
care wheelchairs and accessories, and how the 2016 competitive
bidding program adjusted payment rates for accessories, and how
those rates compared to the 2016 unadjusted fee schedule payment
rates for the same items.
In addition to recognizing that CRT wheelchairs and accessories
are required by individuals with high levels of disabilities, the re-
port also details that these wheelchairs and accessories are not
standard wheelchairs, and they are individually configured to each
person utilizing this technology to meet their specific needs.
The report further states that the information CMS is relying
upon to shift these wheelchairs and accessories from a fixed price
schedule to the competitive bidding process is based on limited in-
formation from only 9 of 109 total bidding areas, which is clearly
insufficient, in order to nationally shift policy. In fact, the report
shows that this shift will bring about significant payment cuts,
33
ranging from 10 to 34 percent, which will only result in increased

costs which are passed along to the consumer.
My legislation is a common-sense approach to addressing one of
the significant issues currently affecting the Medicare system. This
broadly bipartisan legislation is supported by well over 100 Mem-
bers in the House and its companion bill, Senate Bill 2196, also en-
joys significant bipartisan support in the Senate.
This legislation ensures that those who are in need of the most
assistance are not unfairly impacted by this new policy shift.
Mr. Chairman, thank you again for the opportunity to testify on
behalf of this essential piece of legislation. And I yield back the bal-
ance of my time.
Chairman TIBERI. Thank you, Representative Zeldin. Glad you
have you here.
And last, but not least, welcome to the Ways and Means Com-
mittee RoomI think the dean of the New Jersey delegationRep-
resentative Chris Smith.
STATEMENT OF THE HONORABLE CHRIS SMITH, A REPRE-

SENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. SMITH of New Jersey. Mr. Chairman
Chairman TIBERI. You are recognized for five minutes.
Mr. SMITH of New Jersey [continuing]. Thank you very much.
Thank you, Ranking Member. As co-founder with Ed Markey some
16 years ago of the Congressional Alzheimers Task Force, and as
co-chair for the past 16 years, I am very grateful to you for pro-
viding me with the opportunity to speak about my bill, H.R. 1559,
the Health Outcomes Planning and Education for Alzheimers Act,
which now has 286 cosponsors, including many members of this
Subcommittee.
It is very appropriate that we are discussing hope today, as June
is Alzheimers and Brain Awareness Month. As I am sure you are
aware, well over five million Americans suffer from Alzheimers or
related dementia. And as the Baby Boom population ages, that
number is expected to skyrocket unless we find a cure or at least
delay onset.
This disease is devastating. We all know people who have had
itand friends and family membersto both the patient and fam-
ily, alike. Shockingly, many Alzheimers patients do not receive an
accurate diagnosis, especially in the early years. And, according to
the Alzheimers Association, fewer than half of individuals with
Alzheimers are even told of their diagnosis. The 200,000 Ameri-
cans now affected with early onset Alzheimers are especially likely
to get an inaccurate diagnosis.
Alzheimers is also the most expensive disease in America. It in-
curs catastrophic cost to Medicaid and to Medicare: approximately
$236 billion in 2016, alone. On average, Medicare spends three
times more on seniors with Alzheimers than those without. That
is to say about $22,000 for seniors with Alzheimers per year. To
ensure that optimum care to every Alzheimers patient is provided,
we need to find innovative ways to improve the quality of care. Oc-
casionally, such initiatives will actually reduceI say again, re-
duceMedicare spending.
34
The HOPE Act would amend the Social Security Act to add an
additional one-time benefit for care planning services for Medicare
beneficiaries newly diagnosed with Alzheimers disease and related
dementia. This one-time comprehensive care planning session will
arm patients and caregivers alike with the facts, prognosis, and op-
tions for the most efficacious treatment plan that they might pur-
sue. Comprehensive care planning will mitigate huge, unnecessary
costs associated with preventable trips to the hospital and the
emergency rooms.
As far back as 10 years ago an article in the Journal of American
Medical Association entitled, Effectiveness of Collaborative Care
for Older Adults with Alzheimers Disease in Primary Care, Chris-
topher Callahan wrote that there was a savings in a healthy aging
brain center study that found a $3,500 net Medicare savings when
it included such a care planning session. So if people know the
facts, they are more likely to get the care they need earlier, rather
than later, again averting hospital stays and also taking drugs that
might have adverse impacts because of drug interaction.
I would just give you one example that many people are not
aware of. Aricept, which is prescribed to treat symptoms of Alz-
heimers, can be rendered ineffective when used with over-the-
counter medicines such as Sudafed. Very often that is not known.
And again, the drug is not having its positive impact that we would
hope that it would have.
Chairman TIBERI. Without objection.
[The information follows: The Honorable Chris Smith]
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Mr. SMITH of New Jersey. SPIREN, a Washington, D.C.-based

health care consulting firm, conducted a cost estimate for HOPE.
They did it at the behest of the Alzheimers Association. And they
found that a result of this legislation net federal health spending
would decrease by $692 million over a 10-year period. And again,
most of those savings to Medicare would be the result of reduced
hospitalizations and emergency room visits, as well as better medi-
cation management and better management of comorbidity, which
of course is a major problem with people suffering with Alz-
heimers.
I do hope the committee will consider the bill. It already has a
huge majority of the House supporting it. And I yield back the bal-
ance of my time, and I thank you.
Chairman TIBERI. Thank you, Congressman Smith, for your
leadership not only on this bill, but for your leadership on the issue
over the years, over the last 16 years.
Mr. SMITH of New Jersey. Thank you, Mr. Chairman.
Chairman TIBERI. There is hope out there.
So, what a great day, Dr. McDermott. Some great ideas, some
fascinating testimony. And I would like to get back to you on that.
I would like to thank all the colleagues who came before us today,
both from the committee and outside the committee.
I appreciate all the time and work that they have done, that
their staffs have done, that our staffs have done, as we have start-
ed this robust conversation about how we can modernize our health
care system, including reforms to improve and to strengthen our
Medicare system.
And I am happy we have had the time, once again, to pursue reg-
ular order and make the public recordmake a public record of the
efforts that can help us achieve that goal.
So please be advised that Members will have two weeks to sub-
mit written questions that can be answered later in writing. These
questions and answers will be made part of the formal record.
With that, the subcommittee stands adjourned.
[Whereupon, at 3:55 p.m., the subcommittee was adjourned.]
[Submissions for the record follow:]
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House Hearing, 114TH Congress - Legislation To Improve and Sustain The Medicare Program

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House Hearing, 114TH Congress - Legislation To Improve and Sustain The Medicare Program

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LEGISLATION TO IMPROVE AND SUSTAIN THE

COMMITTEE ON WAYS AND MEANS

Printed for the use of the Committee on Ways and Means

U.S. GOVERNMENT PUBLISHING OFFICE

For sale by the Superintendent of Documents, U.S. Government Publishing Office

SUBMISSIONS FOR THE RECORD

WEDNESDAY, JUNE 8, 2016

U.S. HOUSE OF REPRESENTATIVES,

Chairman TIBERI. The subcommittee will come to order. Wel-

We thank you all, witnesses and members of this Subcommittee,

Chairman TIBERI. Thank you, Dr. McDermott. Without objec-

Mr. MCDERMOTT. Mr. Chairman, I have sat here on this Com-

portant supplies including dentures, glasses, and hearing aids. It

When we are running around here, grubbing around, looking for

duction in medical equipment supply stores in our state, just in the

A third bill, H.R. 2138, the Medicare Access To Rural Anesthesia

Thank you, and I yield back.

Unfortunately, there are limitations in place preventing patients

demonstration program they proposed on March 8th of 2016. The

payment codes, one for when the diagnostic procedure is performed

STATEMENT OF THE HONORABLE DAVID G. REICHERT, A REP-

So I look forward to working with you on this bill in advance. It

psychologists to become medical doctors. Rather, it would simply

STATEMENT OF THE HONORABLE CHARLES BOUSTANY, A

Chairman TIBERI. Thank you, Mr. Pascrell. We will go from Jer-

ganizations to furnish services or benefits, unless the agency uses

STATEMENT OF THE HONORABLE ALEX MOONEY, A REP-

pain medication, regardless of whether the patient actually needs

Johnson, Manchin, Capito, Barrasso, Blumenthal, Markey, Toomey,

STATEMENT OF THE HONORABLE LEE ZELDIN, A REPRESENT-

tremely vulnerable group of people suffering from significant dis-

ranging from 10 to 34 percent, which will only result in increased

STATEMENT OF THE HONORABLE CHRIS SMITH, A REPRE-

Mr. SMITH of New Jersey. SPIREN, a Washington, D.C.-based

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